Chest radiographic patterns among HIV positive and HIV negative adults with pulmonary tuberculosis at Mwananyamala hospital TB clinic

Abstract

Background: Tuberculosis is important global health problem. About one-third of the world's population and 30% of HIV positive patients are infected with Mycobacterium tuberculosis. TB patients infected with HIV have radiographic patterns of both primary and post primary pulmonary tuberculosis. Objectives: This study aimed to determine differences in chest radiographic patterns among HIV positive and HIV negative adults. Methodology: Patients newly diagnosed with smear positive PTB were randomly selected, HIV tested and chest radiographic patterns were extracted from re-evaluation of original chest radiographs and their radiologic reports. Results: A total of 170 patients were included among them 100 were males and 70 were females. Fifty four patients (31.8%) were HIV/PTB co-infected. Females were significantly more HIV/PTB co-infected than males (51.4% vs 18.0%, p-value= 0.000). HIV/PTB co-infected patients compared to PTB only patients had significantly lesser cavities (44.4% vs 61.2%, p = 0.040), lesser alveolar consolidation (64.9% vs 81.7%, p = 0.04), HIV/PTB co-infected patients had more left and bilateral lung nodules 85.2% vs 60.9% (p = 0.023) and 70.4% vs 37.5% (p = 0.004) respectively, more miliary nodules (44.4% vs 15.6%, p = 0.003), more left upper, mid and lower zone nodules 59.3% vs 34.4% ( p = 0.028), 77.8% vs 54.7% (p-value = 0.039) and 66.7% vs 34.4% (p = 0.005) respectively. HIV/PTB co-infected patients with CD4 > 200μmol/l had more right mid zone consolidation (40,0% vs 4,5%, p = 0.007). No chest radiographic pattern which was highly associated with severe immunosuppression. Conclusion: Prevalence of HIV among PTB patients is still high (31.8%). Most patients with smear positive pulmonary tuberculosis have abnormal chest radiographs. Pulmonary ix cavities and alveolar consolidation are highly associated with negative HIV status. HIV positive patient with smear positive PTB were more likely to have left or bilateral pulmonary nodules, milliary nodules and left upper, mid and lower zone nodules. Right mid zone consolidation in HIV patients was associated with CD4 counts > 200μmol/l. No radiographic pattern was highly associated with severe immunosuppression. Recommendations: It is recommended that all HIV positive patients with pulmonary radiographic lesions to have sputum smear screening. Patients with pulmonary nodules should be evaluated for pulmonary tuberculosis and HIV. There is a need of more studies focusing on radiographic patterns among HIV positive and HIV negative patients using large community based sample.